Still Struggling to Implement the Science

Although policymakers have been saying that we know what works to slow down or even reverse the HIV epidemic, the world still struggles with implementation of these interventions.

We know stavudine has such a bad side-effect profile that it is rarely used in high-income countries—but we use it anyway in low- and middle-income countries because it is the cheapest antiretroviral available. We know that treating people with HIV before their immune system deteriorates can help them to live longer and prevents further spread of the disease—but we cannot get people tested early enough to catch them before this happens. We have both epidemiologic and cost-effectiveness research that demonstrates the value of giving clean needles and syringes to people who inject drugs—but we hesitate out of unsubstantiated fears that this will lead to even more injecting drug use.

Without the next step that translates research into higher-quality clinical practice and evidence-based policy, the science lacks impact. As noted by UN Special Envoy Prasada Rao, we need ambitious targets in order to generate political will and secure financial commitments. Since we already have the data that identify those targets, it is now a question of whether the other components will fall into place.